Postoperative tonsil/adenoidectomy bleeding management in patients with diagnosed bleeding disorders

Area of Science:

• Otolaryngology
• Hematology
• Surgical Outcomes

Background:

• Tonsillectomy/adenoidectomy (T/A) is common, with 3-5% post-tonsillectomy bleed (PTB) rate.
• Patients with bleeding disorders (BDs) are presumed to have higher PTB risk.

Purpose of the Study:

• To test the hypothesis that a medical management protocol using DDAVP/antifibrinolytic agents for BD patients undergoing T/A results in PTB rates similar to control patients.
• To propose a standardized protocol for BD patients to minimize PTB.

Main Methods:

• Retrospective cohort study of 164 patients (82 BDs, 82 controls) undergoing T/A between 2013-2020.
• BD patients received a standardized protocol involving DDAVP/antifibrinolytics.
• Exclusion criteria included incomplete records and post-surgical BD diagnosis.

Main Results:

• No significant difference in age, sex, estimated blood loss (EBL), or PTB rates between BD and control groups.
• Platelet function disorder was the most common BD (80.5%).
• Of BD patients with PTB, 62% bled 9-10 days postoperatively, and none had severe BD.

Conclusions:

• The implemented protocol for BD patients undergoing T/A yielded PTB rates comparable to control patients.
• Further research is needed to determine optimal postoperative antifibrinolytic treatment duration for BD patients.